Newborn Screening Forms

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The Connecticut Newborn Screening Program

Commonly Used Forms

Click on the links below to access the Connecticut Newborn Screening Program Forms:

Form Type

Authorization to Disclose Health Information or Portion of Sample

Request to Destroy or Return Newborn Dried Bloodspot Screening Sample

Home Birth or Out-of-State Birth Form

Newborn Screening Refusal Waiver Form

Request NBS Collection Supplies

Featured Information

Request Newborn Screening Results

Request newborn screening results directly from our online form (coming soon)

Resources for Parents

Resources and information for parents (coming soon)

Resources for Providers

Helpful resources for health care providers and hospitals (coming soon)